Conversion from a parental anticoagulant to dabigatran
Initiate dabigatran two hours or more prior to the time of the next scheduled dose of the parental anticoagulant like heparin or low molecular weight heparin. If it is from an infusion of heparin that you are trying to convert, initiate dabigatran at the time of discontinuation of heparin infusion.
Conversion from dabigatran to a parental anticoagulant
If the creatinine clearance is thirty milliliters per minute or more, wait twelve hours after the last dose of dabigatran for initiating parental anticoagulant. If the creatinine clearance is less than thirty milliliters per minute, you have to wait for one day.
Conversion from warfarin to dabigatran
Discontinue warfarin and initiate dabigatran when INR (internationally normalized ratio of prothrombin time) is less than 2.
Conversion to warfarin from dabigatran
When to start warfarin while discontinuing dabigatran is depending on the creatinine clearance. If the creatinine clearance is more than fifty milliliters per minute, warfarin can be started three days before discontinuation of dabigatran. If it is between thirty one and fifty milliliters per minute, warfarin is initiated two days before discontinuation of dabigatran. When the creatinine clearance is between fifteen milliliters per minute and thirty milliliters per minute, initiate warfarin one day prior to discontinuation of dabigatran. Please note that the effect warfarin on the INR will be better reflected after dabigatran has been discontinued for two or more days.